Provider Demographics
NPI:1962469676
Name:HEDLUND, TIMOTHY (DO)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:HEDLUND
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 AUTUMN ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ALIQUIPPA
Mailing Address - State:PA
Mailing Address - Zip Code:15001-1301
Mailing Address - Country:US
Mailing Address - Phone:724-375-3199
Mailing Address - Fax:724-375-5858
Practice Address - Street 1:99 AUTUMN ST
Practice Address - Street 2:SUITE 101
Practice Address - City:ALIQUIPPA
Practice Address - State:PA
Practice Address - Zip Code:15001-1301
Practice Address - Country:US
Practice Address - Phone:724-375-3199
Practice Address - Fax:724-375-5858
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS008717L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015843990002Medicaid
OH0244793Medicaid
PA204240OtherUPMC
PA862674OtherBLUE SHIELD
PA862674OtherBLUE SHIELD
080094346Medicare PIN
PAG26053Medicare UPIN